Lateral shoulder graft for microsurgic plasty of hand and foot

The authors have thoroughly studied the versions of anatomic structure, peculiarities of blood circulation and innervation of lateral arm graft at 20 recent cadavers. The graft can be utilized in different modifications; cutaneofascial, subcutaneofascial, musculocutaneous, osteocutaneous. In the clinic were made 8 free microsurgic transplantations of lateral arm graft for plasty of tissues of different genesis in functionally important zones of hand and foot. In long-term post-operative period all patients demonstrated good functional and cosmetic results.     

Anaesthetic hazards of the 'passion gap'. A case report

Dental abnormalities cause problems for both dentist and anaesthetist. The anaesthetic hazards associated with the 'passion gap'--a term used in the western Cape Province for removal of the top four incisor teeth, a practice widespread among members of the Cape Coloured community--are discussed. Recommendations are made to assist the anaesthetist when dealing with such a patient.     

Development of the arthroplasty method in coxarthrosis

On the basis of analysis of surgical treatment of 753 patients with coxarthrosis during 1970-1987, the authors set forth the stages of arthroplasty development in the USSR, using the experience of the Kharkov research institute of orthopaedics and traumatology named after M. I. Sitenko on the problems of arthrodesis operations, endoprosthetics and biological arthroplasty. In the article are presented the peculiar features of diagnostic and surgical tactics in case of patients with idiopathic and dysplastic coxarthrosis; operation technique for each form is presented in details. The authors have developed a new perosseous access to the hip joint, which made a good showing and permits to preserve the integrity of periarticular muscles and neurovascular formations. Application of the given access made possible the extension of indications for arthroplasty in case of grave forms of coxarthrosis, met earlier in a reserved manner.     

Injury Severity Scores in desert recreational all-terrain vehicle trauma

A retrospective analysis of 1,259 patients injured in all-terrain vehicle accidents over a 2-year period was performed. All patients presented to the same community hospital Emergency Department, located near a major desert off-road vehicle recreational area. The patients were characterized by demographics and Injury Severity Scores. There were 2,149 recorded injuries. Mean ISS +/- standard deviation for all patients was 5.07 +/- 4.93; among patients admitted for inpatient care, 9.83 +/- 6.46. Injury Severity Scores were independent of vehicle type (two, three, or four wheels). In this setting, injuries sustained by children were not disproportionately more severe than those sustained by adults. Where documented, alcohol use was associated with higher ISS, and the use of helmets was associated with less severe head and facial injuries. The most common diagnoses in this series were integumental injuries and fractures, frequently involving the face and extremities.     

Late postpartum eclampsia. Apropos of a case

We report the case of a 32-year-old multipara who presented preeclampsia on the fourth day after childbirth without receiving proper treatment that progressed to eclampsia 4 days later. Pregnancy and delivery had been uneventful. The patient presented proteinuria (30 mg/dl), serum total proteins 5.3 g/dl and serum albumin 3.3 g/dl. Blood pressure was controlled with methyldopa, 500 mg at six-hour intervals by intravenous route. The patient presented hypoxemia secondary to bilateral pleural effusion and aspirative pneumonia requiring mechanical ventilation and invasive hemodynamic monitoring. Treatment with cefotaxime, 1 g at six-hour intervals by intravenous route and clindamycin, 600 mg at six-hour intervals by intravenous route was initiated. Sedation was maintained with thiopental sodium, 3 mg/kg/hour in continuous infusion. At dismission, the patient was completely recovered from her clinical picture and needed no antihypertensive therapy. Physiopathologic features and the aforementioned complications are discussed with particular reference to differential diagnosis.     

Maternal and fetal plasma vitamin E to total lipid ratio and fetal RBC antioxidant function during gestational development

Placental transfer of vitamin E was investigated from 19 to 35 weeks of gestation by analysis of fetal and maternal blood samples for total tocopherol, total lipids, and fetal red blood cell antioxidant reserves. Fifty-two fetal blood samples were obtained under ultrasonographic guide by percutaneous umbilical blood sampling. Thirteen were from fetuses with gestational age less than or equal to 22 weeks (x serum vitamin E = 0.4 +/- 0.14 mg/dl), 12 were from fetuses at 23-27 weeks gestation (x serum vitamin E = 0.4 +/- 0.21 mg/dl), and 27 were from fetuses with gestational age 28-38 weeks (x serum level = 0.37 +/- 0.18). Total lipid levels ranged from 140 to 216 mg/dl. Maternal plasma vitamin E concentrations correlated significantly with concurrent values in the fetus. There were no significant differences in serum vitamin E levels or vitamin E to total lipid ratio in samples from early, mid, or late gestation in either the mother or fetus. Red blood cell antioxidant reserve on samples from 18 fetuses were grossly abnormal by three different functional assays. On the basis of these data, placental transfer of vitamin E appears to be relatively constant through advancing gestation. Red blood cell antioxidant reserve is uniformly low.     

The use of the helium-neon laser in the treatment of amblyopia in children

The authors analyze the efficacy of He-Ne laser therapy of amblyopia of various origins in 48 children (81 eyes). Group 1 children were not treated at all in order to assess the visual function background fluctuations (absolute controls). Along with He-Ne laser, used in Group 2, a 'placebo', slit lamp with blinking light, was used in Group 3. Vision acuity was assessed with the use of Sivtsev-Golovin's and Orlova's tables and by visocontrastometry in a blind test. Common visometry has shown a reliable and approximately similar improvement of the vision acuity in Groups 2 and 3 patients, whereas visocontrastometry has not detected any changes of visual function in all the 3 groups. These results cast doubt on the true efficacy of He-Ne laser stimulation of visual function, at least in children, and once again demonstrate that such investigations may be carried out only with a reliable ('blind') control and placebo.     

An infant fatality due to hydroxychloroquine poisoning

A 2 1/2-year-old boy was hospitalized following ingestion of an estimated 60 tablets of 200-mg hydroxychloroquine. Upon death from cardiorespiratory arrest, analytes from the stomach, small intestine, liver, and plasma were examined using UV spectroscopy, thin-layer chromatography, and gas chromatography/mass spectrometry. Results indicate modest drug amounts in the stomach and small intestine, but much higher levels in the blood and liver extracts, suggesting that a considerable overdose was consumed.